“They studied a process called cortical spreading depression, known as CSD, a wave of changes in cells associated with migraine, stroke and head trauma.

“They used a precise two-photon microscopic and oxygen sensor microelectrodes to look at the brains of live mice while they caused this process.

“They saw a swelling occur and the brain cells became starved of oxygen. The nerve cells were damaged — specifically the dendrites, the long, thin spikes that stretch from one nerve cell to another.”

This highlights the importance of using preventives rather than just painkillers during a migraine. Not having a migraine at all prevents other symptoms and the potential for brain damage. In contrast, painkillers treat the pain, they don’t keep the migraine from wreaking havoc on the brain. I’m not sure where triptans fall on this scale, but certainly aborting a migraine is better than having one.

I made a crucial mistake when I created a schedule for myself: I based it on what I should be able to do, not what I can do. It kills me to realize that.

As I made the schedule, I kept thinking how absurd it is that I could only spend six hours a day on work or household stuff. Truth is, I’m lucky if I can get three good hours in a day right now. As hard as I try, I’ll never silence my inner overachiever.

I faced some facts last night. I’m in a horrible migraine and headache spell that began on Christmas Eve. I don’t get to decide that four months is long enough and that the migraines should go away now. I expect too much of myself even when I feel terrible. I’m so tired that implementing any treatment that might provide relief takes more energy than I can spare.

There were good revelations too. I don’t think I’m depressed, just tired, sad and frustrated. Purging the stuff from our house makes me feel better emotionally, if not physically. I don’t have to do anything I don’t feel up to doing. I’m thankful that we don’t have kids or even a dog.

I had a great 45 minutes this morning when I saw that it was sunny, bounded out of bed, showered and started this post. That’s all the peppiness I could spare. At least I’ll make a lot of progress on the baby blanket I’m crocheting while I’m watching baseball. And the sun is still shining — after a Seattle winter, literally is almost as good as metaphorically.

“Is shared experience really necessary for a physician
to understand or treat a patient? I wonder. After all, who would argue
that a cardiologist would be more competent if he had had his own heart
attack, or an oncologist more effective if he had had a brush with cancer?

“Of
course, a patient might feel more comfortable with a physician who has
had personal experience with his medical illness, but that alone
wouldn’t guarantee understanding, much less good treatment.”

I avoided a severe migraine from Thursday to Monday when I was in Phoenix for a wedding. I was extra careful to nap when I needed to (every afternoon!), use caffeine when necessary and take lots of Advil (it was for cramps, but I’m sure it settled my head down too). I’m convinced that the nap is the crucial part of the equation.

The routine was so successful that I have a renewed commitment to get on a schedule. My main goals are to rest, exercise daily, eat wholesome meals regularly, and not stay up too late mucking about on the computer. All of which should ease my migraines. Here’s the schedule I spent the last two hours making:

6:30 – 10:00: Play — eat dinner, spend time with Hart, see friends and maybe some more work (computer off at 10!)

10:00 – 11:00: Get ready for bed, 30 minutes of relaxing yoga, read

I already see flaws. I’d like to spend four solid hours writing for the blog on Mondays. I often have lunch with my friend and yoga teacher after class on Thursdays. Afternoon rest periods usually last two hours. In fact, there’s no way I’ll make it to 2:30 before I need a nap today.

Rigid adherence to the schedule is counterproductive, but I hope to achieve some balance in my days. We’ll see how it goes.

Should You Be Taking Magnesium?
Two doubleblind studies have shown that magnesium supplementation may reduce the frequency of migraine. In research studies, we have found that magnesium levels affect serotonin receptors, and also have an effect on nitric oxide synthesis and release, as well as on NMDA receptors—all brain structures and chemicals suspected to be important in migraine. In small studies, both migraine and cluster headache patients have responded acutely to intravenous magnesium. In a larger double-blind controlled study, the treatment group, receiving 600mg of magnesium for a 12 week period, experienced a 41.6% reduction in headaches as compared to only 15.8% reduction in migraine headaches in the placebo group.

What Does Magnesium Do?
It is responsible for over 300 essential metabolic reactions in the body. It is required for synthesizing proteins in the mitochondria, and for generating energy in most of the body’s basic cellular reactions. It is necessary for several steps in the synthesis of DNA and RNA. Magnesium is also present in a number of other important enzymes. As important as it is intracellularly, 60% of the body’s magnesium is present in bone, and 27% in muscle.

Magnesium Supplements
If you decide to take supplemental magnesium, start at 400-500 mg/day in divided doses. The limiting factor for most people is diarrhea. If you are on a migraine preventative medication that is constipating, like amitriptyline or verapamil, this might be a plus.

WARNING: If you have heart disease or kidney disease, or are prone to kidney stones, talk to your doctor before starting on calcium and/or magnesium.

To be metabolized effectively, magnesium must be taken with calcium. The amount of calcium should be no more than double the amount of magnesium— this is the ratio commonly recommended for women. Men may require less calcium, and sometimes take a ratio of calcium-magnesium that is equivalent mg/mg.

Many people take in only 60-70% of the recommended daily allowance in the first place, and then things like stress and caffeine can deplete that further throughout the day. Migraine sufferers have been found to have a relative magnesium deficiency in their bloodstream between migraine attacks, and intracellular magnesium levels drop even further during a migraine attack.

Magnesium oxide, magnesium citrate, and magnesium sulfate are bioavailable—look for mixed salts of these forms, or magnesium gluconate, which is ionized, and is biologically active; if you develop diarrhea from those forms of magnesium, look for chelated magnesium.

Magnesium carbonate dissolved in CO2- rich water is 30% more bioavailable than magnesium found in foods or in pill-format.

Foods Rich in Magnesium

Peanuts*

Almonds*

Brown rice

Hazel nuts*

Blackstrap molasses

Bananas*

Beans

Tofu*

Soy beans*

Avocado*

Broccoli

Spinach

Swiss chard

Tomato paste

Sweet potato

Pumpkin seeds

Peanut butter*

Chocolate*

Cocoa powder*

Succotash

Cooked artichoke

Black-eyed peas

Whole-grain cereals

Cooked okra

Beet greens

Acorn squash

Chickpeas

Split peas

Lentils

Kiwi fruit*

Apricots

Baked potato

Raisins

Yogurt*

Milk

*these can be migraine triggers for some people

Magnesium-Drug Interactions

Digoxin – Decreased absorption due to magnesium

Nitrofurantoin – Decreased absorption due to magnesium

Anti-malarials – Decreased absorption due to magnesium

May interfere with quinolone or tetracycline antibiotics.

May interfere with anticoagulants.

Diuretics such as furosemide (Lasix) or hydrochlorothiazide can result in magnesium depletion.

Iron supplements may interfere with magnesium supplement absorption.

This article appeared in the April/May 2006 of the Headquarters Migraine Management newsletter, Dr.
Peterson’s bimonthly newsletter on migraine awareness and education. If
you’re not signed up to receive this electronic newsletter, you’re
missing out!

WebMD recently published lots of information on clinical trials. There’s more here than one person can possibly retain, so take small bites!

Is a Clinical Trial Right For You?
Clinical trials are experiments. As such, they may involve risks, often
serious ones. You have no guarantee how the trial will turn out if you choose
to enroll. You also may undergo discomfort, inconvenience, and expense that you
would not have had otherwise. Only you can decide whether joining a clinical
trial is worthwhile or not, based on how you value the possible benefits and
risks.

What to Expect in a Clinical Trial
Every clinical trial is a bit different so there is no typical trial.
Still, you may want to see an example of what a clinical trial really involves
before joining. Here, we’ve created a fictional clinical trial designed to last
one year. The description below resembles the “procedures section” you
would find in the trial’s informed consent document.

Clinical Trials: Benefits and Risks
People participate in a clinical trial for many reasons. Healthy people may
join clinical trials to contribute to medical science and improve medical
knowledge and care for others. If you have a specific illness, clinical trials offer access to new
approaches that are often not available otherwise. You should understand that clinical trials are still experiments. They
involve risks. Here are some of the risks the NIH urges you to consider before
joining a clinical trial.

Clinical Trials: Your Rights and Informed Consent
Informed consent is a crucial aspect of clinical trials. Informed consent is
the process of giving you all of the information that you need to make an
informed decision about a research experiment.

Clinical Trials: 10 Questions to Ask
Before joining a clinical trial, you should feel comfortable and fully
informed. The National Library of Medicine suggests a series of questions to
ask before you enroll in a clinical trial, which we’ve adapted below. You
should know the answers to all of these questions before you enroll.

The focus of clinical trials has changed in recent years. For decades,
researchers mostly enrolled adult men and older women in clinical trials, but
the number of studies devoted to children has grown enormously since 1997.
Clinical trials that include genetic tests have also become increasingly
common. These new developments have changed who enters clinical trials and the
potential risks you may experience if you choose to enroll.